Ankylosing Spondylitis (cont.)

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Catherine Burt Driver, MD

Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.

What are ankylosing spondylitis
symptoms and signs?

The symptoms of ankylosing spondylitis are related to inflammation of the spine, joints, and other organs. Fatigue is a common symptom associated with active inflammation. Inflammation of the spine causes pain and stiffness in the low back, upper buttock area, neck, and the remainder of the spine. The onset of pain and stiffness is usually gradual and progressively worsens with loss of range of motion noticeable over months. Occasionally, the onset is rapid and intense. Lumbar pain (low back pain) and buttock pain are common manifestations of active inflammation in the lumbar spine and sacroiliac joints. The symptoms of pain and stiffness are often worse in the morning or after prolonged periods of inactivity. Motion, heat, and a warm shower often
reduces pain and stiffness in the morning. Because ankylosing spondylitis often affects adolescents, the onset of low back pain is sometimes incorrectly attributed
to athletic injuries in younger patients.

Those who have chronic, severe inflammation of
the spine can develop a complete bony fusion of the spine (ankylosis).
Once fused, the pain in the spine disappears, but the affected individual
has a complete loss of spine mobility. These fused spines are
particularly brittle and vulnerable to breakage (fracture) when
involved in trauma such as motor-vehicle accidents. A sudden
onset of pain and mobility in the spinal area of these patients
can indicate bone breakage. The lower neck (cervical spine) is
the most common area for such fractures.

Chronic spondylitis and ankylosis cause forward curvature
of the upper torso (thoracic spine), which limits breathing capacity.
Spondylitis can also affect the areas where ribs attach to the upper
spine, further limiting lung capacity. Ankylosing spondylitis
can cause inflammation and scarring of the lungs, causing coughing
and shortness of breath, especially with exercise and infections.
Therefore, breathing difficulty can be a serious complication
of ankylosing spondylitis.

People with ankylosing spondylitis can also have arthritis in joints other than the
spine. This feature occurs more commonly in women. Patients may notice pain, stiffness, heat, swelling, warmth, and/or
redness in joints such as the hips, knees, and ankles. Occasionally, the small
joints of the toes can become inflamed or "sausage" shaped. Inflammation can
occur in the cartilage around the breastbone (costochondritis)
as well as in the tendons where the muscles
attach to the bone (tendinitis) and in ligament attachments to bone.
Some people with this disease
develop Achilles tendinitis, causing pain and stiffness in the
back of the heel, especially when pushing off with the foot while
walking upstairs. Inflammation of the tissues of the bottom of the foot, plantar fasciitis, occurs more frequently in people with ankylosing spondylitis.

Other areas of
the body affected by ankylosing spondylitis include the eyes, heart, and
kidneys. Patients with ankylosing spondylitis can develop inflammation of the
iris (iritis),
the colored portion of the eye. Iritis is characterized by redness and pain in
the eye, especially when looking at bright lights. Recurrent attacks of iritis can affect either eye. In addition to the
iris, the ciliary body and choroid of the eye can become inflamed; this is
referred to as uveitis.
Iritis and uveitis can be serious complications of ankylosing spondylitis that
can damage the eye and impair vision and may require an eye specialist's
(ophthalmologist) urgent care. Special treatments for serious eye inflammation
are discussed in the treatment section below. (It should be noted that iritis
and inflammation of the spine can occur in other forms of arthritis such as
reactive arthritis [formerly known as Reiter's syndrome], psoriatic
arthritis, and the arthritis of inflammatory bowel disease.)

A rare complication of ankylosing spondylitis involves scarring of the heart's
electrical system, causing an abnormally slow heart rate (referred to as heart
block). A heart pacemaker may
be necessary in these patients to maintain adequate heart rate and output. In
others, the
part of the aorta closest to the heart can become inflamed, resulting in leakage
of the aortic valve. In this case, patients can develop shortness of breath, dizziness, and heart failure.

Advanced spondylitis can lead to deposits of protein
material called amyloid into the kidneys and result in kidney failure.
Progressive kidney disease can lead to chronic fatigue and nausea
and can require removal of accumulated waste products in the blood
by a filtering machine (dialysis).